ABSTRACT
Background: Impassable caustic esophageal strictures (CES) can be rendered passable through sophisticated dilatation techniques, hence avoiding the esophageal replacement surgery and its complications. Patients and Method: Patients with impassable CES who were presented to our hospital between January 2015 and April 2020 underwent a combined balloon and bougie dilatation. This technique aims at doing an initial partial dilatation of the proximal segment of the stricture, using a balloon catheter to pave the way for the endoscope to be advanced more distally. Therefore, a guide wire could be passed down to the stomach to complete the dilatation session using bougie dilators. Results: Seven patients out of 138 patients who underwent endoscopic dilatation for CES at the pediatric surgery department were enrolled in this study. Their ages ranged from 2.5 to 6 years. This technique was successful in 6 patients indicating technique reproducibility of 85.7%. These 6 patients continued their next dilatation sessions using bougie dilator only, whereas 4 patients were completely cured from dysphagia indicating technique efficiency of 57%, 1 is still on dilatation, and 1 patient had a resistant stricture. The dilatation through the proposed technique failed in 1 patient, who was referred for a replacement surgery. Conclusion: Combined dilatation is safe and effective to preserve the native esophagus in some difficult CES.
Subject(s)
Deglutition Disorders/therapy , Dilatation/methods , Esophageal Stenosis/therapy , Burns, Chemical/complications , Caustics/toxicity , Child , Child, Preschool , Deglutition Disorders/chemically induced , Endoscopy, Gastrointestinal , Esophageal Stenosis/chemically induced , Female , Humans , Male , Reproducibility of ResultsABSTRACT
BACKGROUND: Difficult caustic esophageal strictures may need a more sophisticated dilatation technique before referring for esophageal replacement surgery. PATIENTS & METHOD: Retrospective review of caustic esophageal strictures managed at our center between January 2010 and June 2018 was done. Twenty two patients labeled as undilatable strictures were enrolled. These patients had another trial for endoscopic dilatation using retrograde approach. RESULTS: Among these 22 patients, 5 patients could be dilated by antegrade approach. Seventeen patients had a trial of retrograde dilatation after failed antegrade endoscopy. Retrograde dilatation was successful in 14 patients (82%). Nasogastric tube was left following dilatation in 4 patients to facilitate next sessions. Collectively, 19 out of the 22 patients could have their esophagus dilated in the first instance (86%). Among retrograde dilated patients; eight patients succeeded to retain their native esophagus (57%), two patients are still on dilatation with marked improvement (14%), and three patients underwent colon interposition owing to refractory stricture despite frequent dilatations. CONCLUSION: Every attempt should be tried to preserve the native esophagus. Retrograde endoscopic dilatation is a valuable alternative for undilatable stricture before referring the patient for replacement surgery. LEVEL OF EVIDENCE: This is a case series with no comparison group (level IV).
Subject(s)
Burns, Chemical , Dilatation/methods , Endoscopy/methods , Esophageal Stenosis , Burns, Chemical/complications , Burns, Chemical/surgery , Esophageal Stenosis/etiology , Esophageal Stenosis/surgery , Feasibility Studies , HumansABSTRACT
PURPOSE: The first line of management of benign esophageal stricture is endoscopic dilatation; however, multiple sessions are usually indicated especially in resistant cases. Topical Mitomycin C (MCC) application is a new adjuvant treatment in the management of esophageal stricture with promising results in different case series. Several techniques have been reported for application; nevertheless, the ideal technique has not been described yet. MATERIAL AND METHODS: In this series we have devised a new technique using both the flexible and the rigid endoscope and a specially designed Nelaton catheter. RESULTS: This technique was applied in 38 sessions for 16 caustic esophageal strictures with technical success in all cases. No procedure-related complications were observed in this series. CONCLUSION: This novel technique is feasible and effective and can be considered as standard for topical MMC application on esophageal stricture.
